Brain connectivity changes after osteopathy

Summary

Use of fMRI to reveal neurophysiological effects following Osteopathic Manual Treatment (OMT) showed significant changes compared to placebo treatment. OMT influences connectivity in cen- tres involved in emotion, behaviour, sensorimotor integration and motor control.

Keywords

Osteopathic Manual Treatment; Neurophysiological effects; Functional brain connectivity; fMRI; Treatment Effects; Manual therapy;

Whilst the effectiveness of osteopathic treatment may not be questionable, the exact mechanisms of its effect have long been under debate. Models have frequently included neurophysiological mechanisms but this recent paper is one of the first to provide a direct investigation of brain mechanisms following OMT.

Neural functional connectivity refers to how brain areas become active and communicate with each other, and can be calculated using functional MRI (fMRI) scans. Such patterns of communi- cation are important to dynamically drive behaviour and cognition: the brain organising as a whole, rather than viewing specific areas of function in isolation.

This randomised manual placebo-controlled trial of 30 healthy, pain-free, osteopathy-naive sub- jects involved two groups: Osteopathic Manual Treatment and Placebo Group. fMRI scans were taken before, immediately after, and three days after a 45-minute treatment. All subjects were ex- amined osteopathically before treatment. The osteopathic group received a treatment based on examination findings and included variably: visceral techniques; myofascial release; cranial treat- ment; indirect techniques; manipulations. Subjects in the placebo group were also examined but received a set procedure of “passive touch” to different body areas without mobilisation.

Results showed an increase in activity and connectiveness in areas related to motor control im- mediately after OMT treatment yet activity decreased in the same area following placebo treat- ment. 3 days later, activity decreased significantly in the caudate area (an area involved in control of movements and muscle tone but also activated during stress) for the OMT group yet increased in the placebo group. There was also a change in activity and connections in the amygdala both immediately (decreased) and 3-days (increased) after OMT but again, the opposite was found in the placebo group. The amygdala integrates multiple emotional, behavioural and motivational in- puts, and helps activate appropriate behaviour after processing fear or threat stimuli. Similar changes were found in the other sensorimotor areas including the cerebellar vermis III (posture, locomotion). There was no significant change between scans taken before treatment and 3-days later implying a reversible treatment effect.

The changes in neural connectivity after OMT, with the opposite effects in the placebo group, was striking. This type of study could well be an emerging area of osteopathic research: use of the rapidly developing neurophysiological investigative field to highlight some of the mechanisms of Osteopathy. It is in line with other studies demonstrating functional brain connectivity changes following chiropractic, therapeutic touch, spinal manipulation. It should be noted, however, the broad variety of osteopathic techniques utilised makes it difficult to interpret which, and what as- pect of the osteopathic encounter, had what effect. Overall, it is encouraging to see a study using fMRI that specifically looks at osteopathy.

Reference: Tramontano M, Cerritelli F, Piras F, Spanò B, Tamburella F, Piras F, Caltagirone C, Gili T. Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Brain Sciences. 2020; 10(12):969. https://doi.org/10.3390/brain- sci10120969